Dementia decline

The compounds used to palliate the mnemonic and cognitive decline associated with dementia include cerebral vasodilators and the so-called nootropic agents. These materials enhance cerebral metaboHsm. Agents which enhance neurotransmitter function are in most cases cholinergic. 

While the prevalence of DSP continues to rise as patients with HIV infection live longer, the incidence of HIV-associated neuropathy may be on the decline. Schifitto et al in the Northeast AIDS Dementia (NEAD) Consortium estimated the 1-year incidence of symptomatic neuropathy in a cohort of patients on HAART at 21% (Schifitto et al. 2005), compared to an incidence of 36% in a prior cohort from the pre-HAART era (Schifitto et al. 2002). This suggests that HAART may change the natural history of HIV-associated DSP (Comblath and Hoke 2006). 

Nootropics Slow cognitive decline in dementia Aricept, tacrine... 

Alzheimer s disease A progressive neurodegenerative disorder and the most common type of senile dementia. It is characterised by a marked decline in cognitive functioning and severe behavioural disturbances. 

Alzheimer s disease is the most common form of age-related dementia and one of the most serious health problems in the industrialized world. AD is an insidious and progressive neurodegenerative disorder that accounts for the vast majority of dementia and is characterized by global cognitive decline and the accumulation of P-amyloid deposits and neurofibrillary tangles in the brain. Family history is the second greatest risk factor for... 

McShane R, Keene J, Gedling K et al. (1997) Do neuroleptic drugs hasten cognitive decline in dementia Prospective study with necropsy follow up. BMJ 314(7076) 266-270 Mortimer AM, Shepherd CJ, Rymer M et al. (2005) Primary care use of antipsychotic drugs an audit and intervention study. Ann Gen Psychiatry 4 18 DOI 10.1186/1744-859X-4-18 Mulsant BH, Pollock BG, Kirshner M et al. (2003) Serum anticholinergic activity in a community-based sample of older adults relationship with cognitive performance. Arch Gen Psychiatry 60(2) 198-203... 

Dementia is characterised by a progressive decline in cognitive function. The prevalence of dementia increases with age. With the demographical changes, the number of patients with dementia will increase. There are three major forms of dementia Alzheimer s disease, vascular dementia and a mixed dementia. Beside these, there are several less common subtypes of dementia. 

Dementia An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH]... 

Ginkgo has been examined in a number of clinical populations, including Alzheimer s disease, vascular dementia, and age-associated cognitive decline. Most studies employed the extracts EGb 761 or LI 1370. Many have methodological flaws including limited sample size or insufficient description of randomization, patient characteristics, measurement techniques, or result presentation, but there are a number of well-controlled studies available for drawing preliminary conclusions (Field and Vadnal 1998). 

Although the meta-analysis by Oken and colleagues examined efficacy in Alzheimer s disease only, improvements have been seen in other conditions such as age-related memory decline and vascular dementia (Kanowski et al. 1996 Haase et al. 1996 Allain et al. 1993). More research is needed to establish the quantitative clinical significance of ginkgo extract. 

Hydergine is for treatment of dementia. It has been approved by the Food and Drug administration for treatment of "idiopathic decline in mental capacity."... 

Dementia, a clinical syndrome associated with a variety of distinct pathological causes, is characterized by deterioration in multiple areas of higher intellectual function. As a result, it interferes with the ability to carry out routine daily activities. The symptoms of dementia fall into three categories intellectual (cognitive) deterioration, functional decline, and behavioral/emotional complications. 

Although memory is the most conspicuous intellectual problem in dementia, the decline eventually affects other abilities as well. The other losses include ... 

Apraxia is an inability to carry out coordinated physical activity. This occurs despite no paralysis or weakness. It is believed to result from a decline of visual and spatial abilities. Early in the illness, demented patients may have problems drawing three-dimensional figures. As the illness progresses, they may get lost in familiar neighborhoods or forget how to use a common object like a toothbrush or a hammer. With certain types of dementia they may even forget how to walk (gait apraxia). 

Complications of Dementia. Patients with dementia must have at least two of the following intellectual deficits that are accompanied by a functional decline. They often have other behavioral or emotional complications, but these are not required symptoms. The optional complications listed in the DSM-IV diagnostic criteria are ... 

The course of illness depends on the cause of dementia. As a rule, the degenerative dementias are slowly progressive, taking several years to run their course from initial diagnosis to death. Vascular dementia, like other degenerative dementias, is slowly progressive but in a stepwise fashion. A patient with vascular dementia will function at a particular plateau until another small infarct causes a small but noticeable and sudden decline. 

Any concerns about a decline in memory or other intellectual skills in an elderly patient should lead you to perform an assessment for dementia. During your interview, you should look for signs of memory-related problems. You should ask the following questions of both the patient and a family member ... 

Normal Aging. As we previously mentioned, most people experience noticeable changes in intellectual functioning as they age. It may become slightly more difficult to learn new information, but dementia is not part of the normal aging process. A decline that interferes with someone s ability to carry out the routine mental tasks of daily life is not normal. It is not to be expected. It is instead a sign of illness that should be investigated. 

Four factors can help distinguish delirium from dementia. First, delirium usually has a rapid onset whereas dementia invariably has a gradual, often nearly imperceptible, onset and course. Second, delirium is marked by rapid fluctuations from clear, lucid thinking to confusion and agitation. These shifts may occur several times over the course of a single day. The cognitive decline of dementia does not fluctuate in this manner. Third, delirious patients are often stuporous and inattentive whereas those with dementia are alert but confused. Finally, visual and auditory hallucinations are common in delirium but less so in dementia. 

Donepezil (Aricept). Donepezil is the second cholinesterase inhibitor approved for the treatment of dementia. Most physicians find it much easier to use than its predecessor. It can be given once a day and carries none of the risk of liver toxicity seen with tacrine. It has been shown in multiple clinical trials to delay the decline in cognitive function in patients with Alzheimer s disease. 

Delirium. Anytime you notice a sudden decline in a dementia patient, you should suspect delirium. Any time you notice a drowsy, stuporous patient, you should suspect delirium. If you suspect delirium, immediately send the patient for a medical examination. 

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